Challenges of Rurality: Contingency Management for Stimulant Use in a Primary Care Setting
Abstract
From 2013 to 2019, age-adjusted overdose deaths involving stimulants in the United States increased by 317%. However, there remains no clear pharmacological treatment for psychostimulant use. Contingency management (CM) is an evidence-based intervention for stimulant use disorders. This pilot effectiveness study examined the feasibility of CM targeting abstinence from cocaine and methamphetamine among individuals receiving medication-assisted treatment (MAT) in a rural Appalachian primary care setting. The pilot study encountered substantial challenges related to comorbidity, structural barriers, and treatment engagement. Given that these challenges are common across the region, illustrative case examples are used to contextualize barriers to CM implementation in rural Appalachia. Participants completed twice-weekly monitoring of stimulant abstinence for 12 weeks, with a 3-month follow-up. Oral drug screens verified abstinence and were selected to enhance feasibility and acceptability in rural settings with transportation, childcare, and financial barriers. During sessions, participants discussed factors contributing to stimulant use or abstinence. Negative drug screens were reinforced using a fishbowl prize draw for gift cards ($0–$100), with escalating draws for consecutive stimulant-negative screens. Outcomes varied across participants. Participant A, a 49-year-old White female, did not experience sustained benefit, likely due to significant psychosocial stressors, fluctuating readiness for change, and difficulty attending twice-weekly sessions. Participant B, a 33-year-old White female with two children, demonstrated high motivation and protective factors such as social support and coping strategies, and maintained stimulant abstinence through the 3-month follow-up. Clinic patient C, a 39-year-old White male who declined CM due to access barriers, benefited from harm reduction–focused, home-based care and ultimately achieved sustained abstinence. Structural barriers, low motivation for stimulant abstinence, limited clinical integration, and insufficient incentive magnitude constrained CM effectiveness. These findings highlight the need for flexible delivery models, higher incentives, deeper integration into primary care, and complementary harm reduction approaches in rural settings.
Start Time
15-4-2026 3:30 PM
End Time
15-4-2026 4:30 PM
Room Number
304
Presentation Type
Oral Presentation
Presentation Subtype
Grad/Comp Orals
Presentation Category
Health
Student Type
Graduate
Faculty Mentor
Meredith Ginley
Challenges of Rurality: Contingency Management for Stimulant Use in a Primary Care Setting
304
From 2013 to 2019, age-adjusted overdose deaths involving stimulants in the United States increased by 317%. However, there remains no clear pharmacological treatment for psychostimulant use. Contingency management (CM) is an evidence-based intervention for stimulant use disorders. This pilot effectiveness study examined the feasibility of CM targeting abstinence from cocaine and methamphetamine among individuals receiving medication-assisted treatment (MAT) in a rural Appalachian primary care setting. The pilot study encountered substantial challenges related to comorbidity, structural barriers, and treatment engagement. Given that these challenges are common across the region, illustrative case examples are used to contextualize barriers to CM implementation in rural Appalachia. Participants completed twice-weekly monitoring of stimulant abstinence for 12 weeks, with a 3-month follow-up. Oral drug screens verified abstinence and were selected to enhance feasibility and acceptability in rural settings with transportation, childcare, and financial barriers. During sessions, participants discussed factors contributing to stimulant use or abstinence. Negative drug screens were reinforced using a fishbowl prize draw for gift cards ($0–$100), with escalating draws for consecutive stimulant-negative screens. Outcomes varied across participants. Participant A, a 49-year-old White female, did not experience sustained benefit, likely due to significant psychosocial stressors, fluctuating readiness for change, and difficulty attending twice-weekly sessions. Participant B, a 33-year-old White female with two children, demonstrated high motivation and protective factors such as social support and coping strategies, and maintained stimulant abstinence through the 3-month follow-up. Clinic patient C, a 39-year-old White male who declined CM due to access barriers, benefited from harm reduction–focused, home-based care and ultimately achieved sustained abstinence. Structural barriers, low motivation for stimulant abstinence, limited clinical integration, and insufficient incentive magnitude constrained CM effectiveness. These findings highlight the need for flexible delivery models, higher incentives, deeper integration into primary care, and complementary harm reduction approaches in rural settings.
